By Natalia Barolin, Health Communications Manager, IQ Solutions Inc.
As he treated patients in a Montana rural health clinic, Ed Ehlinger, M.D., M.S.P.H. (UNC 1978–1980) thought there had to be a better way to tackle the health problems facing his community. “I wanted to find a way for medicine to address the underlying health problems,” recalls Ehlinger. After two years with the National Health Service Corps, this vision led him to the Clinical Scholars program and eventually to his current role as Minnesota’s Commissioner of Health.
Ehlinger is not the only Clinical Scholar to serve as a commissioner of health. Rhode Island’s former Commissioner of Health, David Gifford, M.D., M.P.H., (UCLA 1992–1994), says that being a Clinical Scholar allowed him to ask the right questions that enabled him to affect health care beyond the bedside and outside of academia.
New York’s current Commissioner of Health, Nirav R. Shah, M.D., M.P.H., (UCLA 2001–2003) credits the Clinical Scholars program with teaching him the basic tenet of his success: the importance of being able to see the “big picture.” Not one of these physicians had their sights set on the job of health commissioner, but their Clinical Scholars training put them on the pathway to public service leadership.
A Career's Unexpected Turns
Ehlinger planned to pursue a career as a primary care physician in a rural community, but life, and more specifically his wife, had different plans. After his wife was accepted to a Ph.D. program in Minnesota, Ehlinger landed a job with the Minneapolis Health Department. It was in this job that he fell in love with urban health. Ehlinger credits this combination of experience as a critical tool for his job as Minnesota’s Commissioner of Health. “My dreams for rural health, combined with my new love for urban health, gave me a very unique perspective in my role now where I have to address both.”
For David Gifford, listening to Mark Chassin, M.D. (UCLA 1976-1978), president of the Joint Commission, speak about what it was like to be the Health Commissioner of New York, would change the course of his career. “I remember thinking, wow, that’s something I never would have thought about,“ recalls Gifford. He also took advice from John M. Eisenberg, M.D., M.B.A. (Penn 1974-1977), chief of the Division of General Internal Medicine at the University of Pennsylvania at the time, who talked about developing expertise in academics so that it could be applied in civil service. Gifford’s exposure to both Chassin and Eisenberg was possible because of the Clinical Scholars program.
Shah, New York’s youngest health commissioner, was working in academia and hadn’t considered public service until he was tapped for the position after briefly serving on the selection committee. He credits the experience and training afforded by his RWJF fellowships and grants for positioning him as the right candidate. “As a Clinical Scholar, I was able to step back and ask more important policy questions, as opposed to getting stuck in the weeds,” remembers Shah. “This suddenly made my work more policy relevant.
Crisis or Opportunity for Change?
Shah believes that recent fiscal crises created the opportunity of a lifetime to reform the health care system. “In New York, we’ve seen how folks who literally never speak to each other are working together to improve health care. There is fundamental reform going on because we have no choice,” says Shah. But no one thinks this will be easy. Ehlinger acknowledges “that our entire system of care is used to functioning in silos.” He argues, “We need to start more upstream, work on prevention, and build community ownership so that entire populations are engaged in improving health and health care.”
For example, in Minnesota, Ehlinger is leading the Statewide Health Improvement Program (SHIP), engaging worksites, schools, health care organizations and other community organizations to address obesity due to physical inactivity and unhealthy eating, as well as tobacco use. In New York, Shah is working on a proposal to ensure that more New Yorkers have a medical home.
After a wrong-site surgery brought medical errors to the attention of Rhode Islanders, Gifford wanted to address the systemic problems. He knew punishing the individual or institution would not help, so he reached out to Mark Chassin. That phone call led to a Joint Commission pilot program at a hospital in Rhode Island to look at organizational culture and leadership to address medical errors from a systems-based approach.
A Responsibility to Serve
Shah, who is just 5 months into his role as health commissioner, is experiencing a steep learning curve in public office. In addition to a culture shift from academia, Shah notes that there are many more stakeholders whose voices and opinions must be addressed, and often the stakeholders he hopes will speak up, do not. “The nature of bureaucracy is to resist change,” he says. “You need patience to see your vision and ideas realized.”
Being a Clinical Scholar alumnus certainly helps on the job. All three have tapped the network of fellow scholars and colleagues in health care to help them address challenges they’ve encountered. Shah, who is also an alumnus of the RWJF Physician Faculty Scholars program (2007–2010), and a RWJF Health e-Technologies Initiative grantee (2004), advises, “The RWJF programs truly create generalists who are prepared to influence policy. Delving into policy is not only an option but a responsibility of folks who want to make a mark and change our health care system.”